Provider Demographics
NPI:1245796655
Name:LEUCK, LAUREN E (PA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:E
Last Name:LEUCK
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:6350 CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4107
Mailing Address - Country:US
Mailing Address - Phone:757-213-5700
Mailing Address - Fax:757-213-5701
Practice Address - Street 1:3000 COLISEUM DR STE 104
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5963
Practice Address - Country:US
Practice Address - Phone:757-827-9400
Practice Address - Fax:757-827-9320
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2020-06-26
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Provider Licenses
StateLicense IDTaxonomies
VA0110007117363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant